Journal of General Internal Medicine

, Volume 26, Issue 1, pp 77–82 | Cite as

Update in Addiction Medicine for the Generalist

  • Adam J. Gordon
  • Hillary V. Kunins
  • Darius A. Rastegar
  • Jeanette M. Tetrault
  • Alexander Y. Walley

Key words

review substance-related disorders primary health care primary care alcoholism and addictive behavior drug abuse smoking cessation 



We acknowledge the editorial assistance of Margaret Krumm in preparation of this manuscript. No financial support was received by the authors for the work represented in this manuscript. This work was presented in an invited oral presentation at the 2010 Annual meeting of the Society of General Internal Medicine. Minneapolis, Minneapolis, May 1, 2010.

Conflict of Interest

None disclosed


  1. 1.
    Robins LN, Helzer JE, Weissman MM, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984;41(10):949–58.PubMedGoogle Scholar
  2. 2.
    Institute of Medicine. Improving the quality of healthcare for mental and substance-use conditions: The quality chasm series. Washington, DC: The National Academies Press; 2005.Google Scholar
  3. 3.
    Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: The National Academies Press; 2001.Google Scholar
  4. 4.
    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.CrossRefPubMedGoogle Scholar
  5. 5.
    Gordon AJ, Sullivan LE, Alford DP, et al. Update in addiction medicine for the generalist. J Gen Intern Med. 2007;22(8):1190–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Gordon AJ, Fiellin DA, Friedmann PD, et al. Update in addiction medicine for the primary care clinician. J Gen Intern Med. 2008;23(12):2112–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92.PubMedGoogle Scholar
  8. 8.
    Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300(22):2613–20.CrossRefPubMedGoogle Scholar
  9. 9.
    Anchersen K, Clausen T, Gossop M, Hansteen V, Waal H. Prevalence and clinical relevance of corrected QT interval prolongation during methadone and buprenorphine treatment: a mortality assessment study. Addiction. 2009;104(6):993–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Paulozzi LJ, Logan JE, Hall AJ, McKinstry E, Kaplan JA, Crosby AE. A comparison of drug overdose deaths involving methadone and other opioid analgesics in West Virginia. Addiction. 2009;104(9):1541–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Krantz MJ, Martin J, Stimmel B, Mehta D, Haigney MC. QTc Interval Screening in Methadone Treatment: the CSAT Consensus Guideline. Ann Intern Med. 2008.Google Scholar
  12. 12.
    Gourevitch MN. First do no harm…Reduction? Ann Intern Med. 2009;150(6):417–8.PubMedGoogle Scholar
  13. 13.
    McLellan AT, Turner BJ. Chronic noncancer pain management and opioid overdose: time to change prescribing practices. Ann Intern Med. 2010;152(2):123–4.PubMedGoogle Scholar
  14. 14.
    Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. Am J Prev Med. 2008;34(2):143–52.CrossRefPubMedGoogle Scholar
  15. 15.
    D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Med Care. 2005;43(3):229–36.CrossRefPubMedGoogle Scholar
  16. 16.
    Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test. J Gen Intern Med. 2009;24(7):783–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Friedmann PD, McCullough D, Chin MH, Saitz R. Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000;15(2):84–91.CrossRefPubMedGoogle Scholar
  18. 18.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption–II. Addiction. 1993;88(6):791–804.CrossRefPubMedGoogle Scholar
  19. 19.
    Allen JP, Litten RZ, Fertig JB, Babor T. A review of research on the Alcohol Use Disorders Identification Test (AUDIT). Alcoholism: Clinical & Experimental Research. 1997;21(4):613–9.Google Scholar
  20. 20.
    The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183-94.Google Scholar
  21. 21.
    Vinson DC, Kruse RL, Seale JP. Simplifying alcohol assessment: two questions to identify alcohol use disorders. Alcohol Clin Exp Res. 2007;31(8):1392–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Dawson DA, Grant BF, Stinson FS, Zhou Y. Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcohol Clin Exp Res. 2005;29(5):844–54.CrossRefPubMedGoogle Scholar
  23. 23.
    Gordon AJ, Maisto SA, McNeil M, et al. Three questions can detect hazardous drinkers. J Fam Pract. 2001;50(4):313–20.PubMedGoogle Scholar
  24. 24.
    Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Arch Intern Med. 1998;158(16):1789–95.CrossRefPubMedGoogle Scholar
  25. 25.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  26. 26.
    Cervantes EA, Miller WR, Tonigan JS. Comparison of Timeline Follow-Back and Averaging Methods for Quantifying Alcohol Consumption in Treatment Research. Assessment. 1994;1(1):23–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Maisto SA, Conigliaro JC, Gordon AJ, Mcginnis KA, Justice AC. An experimental study of the agreement of self-administration and telephone administration of the Timeline Followback interview. J Stud Alcohol Drugs. 2008;69(3):468–71.PubMedGoogle Scholar
  28. 28.
    Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99(1–3):280–95.CrossRefPubMedGoogle Scholar
  29. 29.
    Krupski A, Sears JM, Joesch JM et al. Impact of brief interventions and brief treatment on admissions to chemical dependency treatment. Drug Alcohol Depend. 2010.Google Scholar
  30. 30.
    Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;28(3):7–30.CrossRefPubMedGoogle Scholar
  31. 31.
    The impact of screening, brief intervention, and referral for treatment on emergency department patients' alcohol use. Ann Emerg Med. 2007;50(6):699-710, 710.Google Scholar
  32. 32.
    Fleming MF, Barry KL, Manwell LB, Johnson K, London R. Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. JAMA. 1997;277(13):1039–45.CrossRefPubMedGoogle Scholar
  33. 33.
    Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL. Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 2002;26(1):36–43.PubMedGoogle Scholar
  34. 34.
    Otto C, Crackau B, Lohrmann I, et al. Brief intervention in general hospital for problematic prescription drug use: 12-month outcome. Drug Alcohol Depend. 2009;105(3):221–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Zahradnik A, Otto C, Crackau B, et al. Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients. Addiction. 2009;104(1):109–17.CrossRefPubMedGoogle Scholar
  36. 36.
    McQueen J, Howe TE, Allan L, Mains D. Brief interventions for heavy alcohol users admitted to general hospital wards. Cochrane Database Syst Rev. 2009;(3):CD005191.Google Scholar
  37. 37.
    Guth S, Lindberg SA, Badger GJ, Thomas CS, Rose GL, Helzer JE. Brief intervention in alcohol-dependent versus nondependent individuals. J Stud Alcohol Drugs. 2008;69(2):243–50.PubMedGoogle Scholar
  38. 38.
    Stewart SH, Latham PK, Miller PM, Randall P, Anton RF. Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study. Addiction. 2008;103(10):1622–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Anton RF, O'Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006;295(17):2003–17.CrossRefPubMedGoogle Scholar
  40. 40.
    Nordback I, Pelli H, Lappalainen-Lehto R, Jarvinen S, Raty S, Sand J. The recurrence of acute alcohol-associated pancreatitis can be reduced: a randomized controlled trial. Gastroenterology. 2009;136(3):848–55.CrossRefPubMedGoogle Scholar
  41. 41.
    Gunnell D, Irvine D, Wise L, Davies C, Martin RM. Varenicline and suicidal behaviour: a cohort study based on data from the General Practice Research Database. BMJ. 2009;339:b3805.CrossRefPubMedGoogle Scholar
  42. 42.
    Quinn VP, Hollis JF, Smith KS, et al. Effectiveness of the 5-As tobacco cessation treatments in nine HMOs. J Gen Intern Med. 2009;24(2):149–54.CrossRefPubMedGoogle Scholar
  43. 43.
    Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2008;(3):CD006103.Google Scholar
  44. 44.
    Kuehn BM. Studies linking smoking-cessation drug with suicide risk spark concerns. JAMA. 2009;301(10):1007–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Kasliwal R, Wilton LV, Shakir SA. Safety and drug utilization profile of varenicline as used in general practice in England: interim results from a prescription-event monitoring study. Drug Saf. 2009;32(6):499–507.CrossRefPubMedGoogle Scholar
  46. 46.
    Walley AY, Alperen JK, Cheng DM, et al. Office-based management of opioid dependence with buprenorphine: clinical practices and barriers. J Gen Intern Med. 2008;23(9):1393–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Drug Addiction Treatment Act of 2000, 42 USC§3502a, Drug Addiction Treatment Act of 2000, (2000)Google Scholar
  48. 48.
    Barry DT, Irwin KS, Jones ES et al. Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study. J Gen Intern Med. 2008.Google Scholar
  49. 49.
    Soeffing JM, Martin LD, Fingerhood MI, Jasinski DR, Rastegar DA. Buprenorphine maintenance treatment in a primary care setting: outcomes at 1 year. J Subst Abuse Treat. 2009;37(4):426–30.CrossRefPubMedGoogle Scholar
  50. 50.
    Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2004;(3):CD002207.Google Scholar
  51. 51.
    Fiellin DA, Moore BA, Sullivan LE, et al. Long-term treatment with buprenorphine/naloxone in primary care: results at 2-5 years. Am J Addict. 2008;17(2):116–20.CrossRefPubMedGoogle Scholar
  52. 52.
    Parran TV, Adelman CA, Merkin B, et al. Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy. Drug Alcohol Depend. 2010;106(1):56–60.CrossRefPubMedGoogle Scholar
  53. 53.
    Fudala PJ, Bridge TP, Herbert S, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med. 2003;349(10):949–58.CrossRefPubMedGoogle Scholar
  54. 54.
    Gordon AJ, Trafton JA, Saxon AJ, et al. Implementation of buprenorphine in the Veterans Health Administration: Results of the first 3 years. Drug Alcohol Depend. 2007;90:292–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Gordon AJ, Liberto J, Granda S, Salmon-Cox S, Andree T, McNicholas L. Outcomes of DATA 2000 certification trainings for the provision of buprenorphine treatment in the Veterans Health Administration. Am J Addict. 2008;17(6):459–62.CrossRefPubMedGoogle Scholar
  56. 56.
    Miller NS, Sheppard LM, Colenda CC, Magen J. Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. Acad Med. 2001;76(5):410–8.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Adam J. Gordon
    • 1
  • Hillary V. Kunins
    • 2
  • Darius A. Rastegar
    • 3
  • Jeanette M. Tetrault
    • 4
  • Alexander Y. Walley
    • 5
  1. 1.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare System and University of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Albert Einstein College of Medicine and Montefiore Medical CenterNew YorkUSA
  3. 3.Johns Hopkins School of MedicineBaltimoreUSA
  4. 4.Yale University School of MedicineNew HavenUSA
  5. 5.Boston University School of MedicineBostonUSA

Personalised recommendations